One girl's adventures in the History of Medicine.

Nerd Corner

One of the best parts of living the academic life is the opportunity to meet so many interesting people who study so many interesting things. That’s why this page is here – it’s a place where people get to talk (or rant!) about the things they like and why they like ’em! Also, if you would like to contribute to Nerd Corner just shoot me an email at hippocratesandcheese@gmail.com!

Coming Out Fighting!

So Brie asked me to attempt to write a bit of a blog about some of the things I do. I’ve not blogged for a long while, and certainly never written a serious blog post before, but for Brie I’d do anything!

I’m an archaeologist and a prehistorian. I do lots of archaeological theory where I think about how we understand and describe the past. I am also a metal-wear analyst which means I carry out experiments with metals and I study prehistoric metal objects to try and work out how they were made and how and why they might have been used. My research is pretty varied but I have to admit to more than a passing obsession with BRONZE! Bronze is great. It is shiny and sharp and captivating. One of the projects I am involved in is the Bronze Age Combat Project. This, more than a little mad, project aims to investigate combat in the latter half of the Bronze Age in Britain and Ireland (c.1500-800BC). The Bronze Age *shock horror* is marked by the first use of bronze: and it gets everywhere in the form of halberds, swords, spearheads, shields and (mostly) axes (I love axes)!

Bronze has often been seen as a weak material, especially when we compare it to modern steel. When we think of bronze today we might think of beautiful jewellery or stunning sculptures – as a result some archaeologists have suggested that Bronze Age bronze is best associated with prestige and beauty rather than a utilitarian or multi-functional tool or a deadly weapon! From the Middle Bronze Age onwards a diverse range of weapons begin to appear in the archaeological record. Were these weapons used in genuine anger by a violent society? Or where they items of prestige for display by a developing elite? For a long time archaeologists seemed uneasy about addressing the potentially violent nature of our own past – which is another reason that these weapons are often more readily associated with the manoeuvrings of elites for political power rather than murderous killing sprees!

Rachel’s job is cooler than yours…

The Bronze Age Combat Project is designed to begin to address this question. It works in a two-fold way, firstly we got a lot of replica weapons made: swords, spears, axes, leather shields and even a bronze shield! They were accurately re-produced by a bronze smith using traditional techniques and proportions of copper and tin, they were work hardened and sharpened to give functional edges. We designed a set of experiments to test these weapons in various combat scenarios – sword on sword parries, spear throws, sword and spear stabs, sword on spear parries and many more besides! Each one of these combat scenarios was broken down into individual moves, each move was carried out and then all the marks that the combat manoeuvers left on the weapons were recorded first in the field and then, more accurately, in the lab. These experiments are creating a reference collection which in the long run will be available online for others to use, share, enjoy(?). Now with our reference collection in our back pocket we are setting out to use it as the basis to look at prehistoric weapons to understand whether they were truly used!

The project is far from complete, but I know that you are all desperate to know what weapons you need and how to use them in case you get transported back in time to the Bronze Age…

Shield of Bronze!

First off, you want a bronze shield – before the experiments I thought that this shield would fail woefully but as it turns out these are tough old beasts! We threw spears at them and stabbed and attacked them with spears and swords, and whilst we could indeed bend it, we could not break it! You might be inclined to want a sword to go with your shield – I can see why, swords look cool. I would advise against this. In our experiments when two people truly clashed swords, and the ‘defender’ fought back, massive notches appeared in the sword, but worse still they bent A LOT:

Bendy…

…with cracks and fissures often appearing in the surface of the swords! You can always bend a sword back again, but over time it weakens and you will have to re-heat and re-work it to make it strong again. Protecting your blade from the clashes and blows of your opponent would be high on your agenda if you were to be a Bronze Age warrior.

Spear!

The spear however, is a different story! The spear won’t let you down. Mounted on a short shaft, you can throw it and stab with it, but you can also use it in more diverse ways to parry away the attacks of a sword. You can use the shaft to bop people, to ward them away, and to give you extra reach to attack from a safe distance. We worked a lot with spears and we were able to use them to effectively defend and fight, and whilst they did suffer damage there are none that are so damaged as to be un-useable, and even those that had their sockets bent, or their shafts broken could still be mounted back onto a fresh shaft in the twinkling of an eye.

Dr. Rachel Crellin is a Leverhulme Early Career Fellow at the University of Leicester working on a project entitled “New materials, new worlds: understanding the uses of Bronze Age axes.” Dr. Crellin hails from the Isle of Man and has a penchant for wearing the color mustard. If you want to know more about Bronze Age weapons (or anything else Manxy and/or Archaeological) feel free to email her at rjc65@le.ac.uk!

A Medical Anthropologist rambles about TB and the History of Medicine

Hi my name is Kris and I love tuberculosis.

Okay let me rephrase: I am hopelessly addicted to researching and reading about tuberculosis. And talking about tuberculosis in inappropriate places and at inappropriate times, mainly wedding receptions. See, when I feel really awkward or out of place I start talking, and since I don’t know any particularly funny jokes I go with what I know, and what I know is tuberculosis. Because I love to research and read about it.

Don’t you want to invite me to your next party yet?

I should back up: years ago in my first days at university I took an anthropology course because I was required to, and I loved it so I took more. And then I took a medical anthropology class and REALLY loved it, and that’s how my obsession with infectious disease and epidemiology came to be. For those who don’t know (i.e. most everyone) anthropology, in it’s most basic form, is the study of humans, past and present, and how they live and interact with their environments (i.e. cultures). Medical anthropology is a subfield of anthropology and again, in it’s most basic form, investigates how health influences cultures, and how culture influences health. The use of ancient and ‘natural’ medicine in modern medical times, for example, is a big field of study in medical anthropology. Unfortunately medical anthropology is not the tv show Bones[1] (which, trust us, we hear all the time[2]) but medical anthropology is an extremely important and vital field in the world, in a much larger capacity than most people realise: we lowly anthropologists influence everything from public health to psychology to politics to even engineering. But I’m losing the plot. We’re here to talk about tuberculosis.

In my professional career as a medical anthropologist I focus mainly on infectious disease and the epidemiology of infectious disease, which means I look at how infectious diseases move about in this crazy world, and if how we live, eat, sleep, etc. influences that in any way. A question I ask in my work on a daily basis is: ‘how does our culture shape how disease affects us’, and the answer is: in colossal ways. It’s vitally important to examine the links between our lifestyles and disease because we can follow those links to find ways to prevent disease from happening.

For example, using my friend tuberculosis: say you have an old building, a tenement building like those found all across the United Kingdom. Tenement buildings are multi-family or multi-occupancy buildings popularised by Queen Victoria as cheap but substantial housing for the poor in urban surroundings[3]. They are still very prominent today because they are cheap to build and can house many people in separate living areas. Modern tenement buildings have separate lines for piping, water, ventilation, etc. But those built in the Victorian ages, and up to only a few decades ago, do not; this was to keep prices down on both the flats/apartments themselves and building costs. So, say you live in a tenement building with ten apartments, each apartment housing a separate family (ten families in a building). If the building was constructed in a certain era, all the ventilation will connect together, and exit the building at one source, usually up through the roof. But what happens if someone on the bottom floor gets sick, with something air-bound, like TB particles? Those TB particles exit the sick persons’ lungs, enter the air ducts, and travel from the first floor all the way up, through all the apartments, until it leaves the building. This means everyone in the building is exposed to TB, and as tuberculosis is extremely infectious, well it’s not a good scenario. But as we’ve already discussed, tenement buildings are cheap to build and house people in, they are perfect for urban environments where there isn’t a lot of room to build horizontally but loads of room to build vertically, and they can house a lot of people. So how do we then address the need for urban living environments while taking into account the potential spreading of disease? In this example, the government developed new legislation that dictates what kind of building supplies can be used for the construction of certain buildings, and strict policies for construction of buildings in urban environments in general. But this took a long time to actually put into place, and was only possible with the assistance of public health professionals.

You’re welcome, world.

That’s just one example of medical anthropology at work. And I know you may be thinking, ‘Um, great Kris, thanks for that super interesting lesson but what does this have to do with the history of medicine? Isn’t that what this blog is about’? And you would be correct. So let’s get back to the point.

When Brie asked me to write a guest post for her super fancy history of medicine blog, we both instantly knew I would write something about tuberculosis (see opening paragraph). But when it comes to the history of tuberculosis, and it’s role in the history of medicine, things can get… well, a little complicated. Tuberculosis is a truly fascinating disease because it’s one of the oldest diseases in the world. And when we say ‘oldest’, we mean tuberculosis was causing all sorts of problems when people were still just trying to figure out how to have civilizations. Skeletal remains show prehistoric humans, circa 4000BC, had TB, and TB has even been located in the bones of Egyptian mummies[4]. Back in good ‘ol Grecian days, tuberculosis was called consumption, after the Greek term Phthisis. Brie’s dear friend Hippocrates first identified the disease as being ‘the most common cases of illness at the time’. Hippocrates refused to believe the disease was contagious instead claiming it was hereditary[5]. But another Greek physician Galen took over the reigns from Hippocrates to be the first to correctly describe the disease as ‘ulceration of the lungs, thorax or throat, accompanied by a cough, fever and consumption of the body by pus’. Discussions of tuberculosis can be found in numerous books focussing on classical antiquity, from the Roman author and engineer Vitruvirus to Pliny the Younger, famous for surviving the destruction of Pompeii.

If that sounds very unpleasant, it’s because it is. Tuberculosis is essentially a bacterium that starts in the lungs and moves quickly through the body (hence why the Greeks referred to tuberculosis as consumption– because the disease literally ‘consumed’ the patient until death). Tuberculosis is extremely contagious, and because it is an air-borne pathogen it is extremely dangerous. As tuberculosis moved throughout the world in the early ages of human civilization it had several names- consumption/phthisis (Greek), the White Plague (Europe), scrofula (India). It is theorised that a certain sickness mentioned in the Bible is actually tuberculosis- in the Old Testament there is mention of a ‘consumptive illness’ that affects the Jewish people if they stray from God. Before science could pinpoint the specific issue, tuberculosis could be found in literally, and I mean literally, every civilization in the world, from ancient China, to Western Europe, and everywhere in between. Then in 1882, a German physician by the name of Robert Koch discovered Mycobacterium tuberculosis, the bacterium that actually causes tuberculosis. Science did some stuff[6], and before long medicine was created to help stop the spread of tuberculosis.

Huzzah right? Unfortunately not. See, as I said before, the history of medicine when referring to tuberculosis is complicated. Some diseases get their super drug and slowly die out, like small pox and most recently[7], Rubella. And indeed, tuberculosis was getting close. Medicine was working, numbers were dwindling, and people were starting to be less freaked out about the disease. And then something interesting happened. Well, interesting from a pathology stand point; terrible and horrible from a public health stand point. The medicine developed for tuberculosis, the medicine that was working so well, started to not work so well any longer. And multi-drug resistant tuberculosis (MDR-TB) came onto the scene.

To understand the modern, social phenomenon of MDR-TB, you have to understand ‘the history of medicine’. Not just the history of what medicine is and was, but what the phrase ‘the history of medicine’ can truly mean in its multidimensional functions, both socially and biologically. MDR-TB came into the world through the very basic forms of medical pathology, and MDR-TB is serious because it is resistant to the most powerful, front-line drug treatments for tuberculosis. This is due to several reasons: weakened immune systems (usually due to other illnesses present such as HIV/AIDS), not following scheduled antibiotic treatments[8], but mostly MDR-TB can be linked to changing mutations in the genomes of TB itself. And that may sounds really fancy and scientific, but when it comes to the study of disease its reality. From a biological standpoint, it thus becomes extremely important to investigate and study the differences in tuberculosis from today’s modern times to the days of Hippocrates and other ancient physicians, so we can better understand how diseases change and alter over the ages, not just in their DNA, but in how the world reacts and interacts with those diseases. With a disease as complicated as tuberculosis it is vital to explore and reflect on the past and present histories of the disease, in order to create a commentary on management. Past physicians such as Hippocrates and his friends focussed on the pulmonary (lung) tuberculosis, which was great at the time, but as John Burnham argued in his historiography of medicine:

‘the focus before the mid-twentieth century was largely ‘iatrocentric’, emphasising individual physicians, and was positivistic or progressive, within a framework of the ‘onward and upward’ march of medical science’.[9]

Modern research into tuberculosis instead tends to focus on the social aspects of the disease itself. Rene Dubos and Jean Dubos, two pioneers in medical sociology, argued in the 1950’s that tuberculosis is a ‘social disease… the consequence of gross defects in social organisation, and errors in individual behaviour’.[10] Indeed, tuberculosis is a disease of the poor, an illness built by constructions of social inequalities and poverty. And thus us modern researchers focus on how to reduce those inequalities, through the creation of social programs with the goal of reducing the spread of the disease. Dr. Paul Farmer, one of the top medical anthropologists in the field of infectious disease research, asks an important question: if certain populations have long been afflicted by these [disorders like tuberculosis], why are the diseases considered ‘new’ or ‘emerging’’?.[11] This is especially true in regards to tuberculosis.

So the ancient histories of disease merge with modern epidemics. Without the work of Hippocrates and his friends, without their work investigating the biology and pathogenesis of tuberculosis, their focus on the ‘consumption’ of the disease, we would not be able to study the social dimensions of the disease today. We would have gotten there eventually, but as is the reality with so many diseases of the world the biological aspects of disease and illness are just one piece of the puzzle. We have to look at the whole histories of disease in order to fully understand it. So the next time you find yourself wondering, ‘why study on ancient medicine, isn’t modern medicine where we need to be focussing?’, remember your friend tuberculosis. TB killed an estimated 1.5 million people worldwide in 2013, in almost every country in the world, and it’s been around for over 6,000 years. Six thousand years. It’s kind of a big deal.

And with that, I leave you. For more information on tuberculosis, medical anthropology- including recommendations on books and lectures/podcasts with some of the best in the field- or why musician Michael Bolton is vastly underrated in his brilliance, feel free to email me anytime. Hope you enjoyed my ranting and ramblings!

[1] See also Indiana Jones and the Temple of Archaeology not Anthropology

[2] That would be forensic anthropology, a really cool and absolutely fascinating subfield of anthropology and extremely important to criminology and psychology, but with significantly less cool technology than what you see on television. For some awesome books on forensics, that people will judge you for reading in public places, check out Dead Men Do Tell Tales by William R. Maples, Death’s Acre (the story of the legendary Body Farm at the University of Tennessee, USA) by William M. Bass, and any books by Kathy Reich, whose stories are what Bones is actually based on.

[3] Ironically tenement buildings were built to get people off the streets and into affordable housing to avoid things like diseases. Whoops. The best laid plans, am I right?

[5] Aristotle disagreed with him, and if I could have a pub dinner with any two people it would be those two so I could hear them fight over the pathogenesis of tuberculosis. Also I would invite Janis Joplin to the table because I’m weird.

[9] Burnham, J.C. (1996). Garrison lecture: how the concept of profession evolved in the work of historians and medicine. Bulletin of the History of Medicine 70(1): 1-24.

[10] Dubos, R., and Dubos, J. (1952). The White Plague: Tuberculosis, man and society. (Boston: Little, Brown and Company 1952, reprint with a foreword by David Mechanic and an introductory essay by Barbara Gutmann Rosenkrantz, New Brunswick: Rutgers 1987), xxxviii.

Kristin (Kris) Childers-Buschle is an American transplant in Edinburgh, Scotland. She has a graduate degree in medical anthropology from the University of Edinburgh and works as a consultant and public health specialist for various organisations across the world, including the World Health Organisation and UNICEF. Her professional experience includes research on global child maltreatment, infectious disease and social dimensions of public health. Her most recent projects include global prevalence reports on fatal child maltreatment and mapping of attitudes and behaviours of victims of the most recent Ebola outbreak in Western Africa. When she is not working you can find her exploring the Scottish Highlands, eating cheesecake and watching funny videos on the internet. She can be contacted at: kechildersbuschle@gmail.com.

Advertisements

Share this:

Like this:

3 thoughts on “Nerd Corner”

To make your friend, Brie, even more interesting to you; her maternal great grandmother died of TB as did several other siblings in that family.
AND ~~ her grandfather’s name was Paul Farmer. Famous for managing bowling alleys in Phoenix during the 50s, 60s, & 70s. Not quite the cachet of your Paul; but interesting none the less.